1. Sandi Clark, RN KDPH Pediatric Section Supervisor/ School Health Nurse Consultant July, 2014

2. School Nursing The National Association of School Nurses (NASN) defines school nursing as a specialized practice of professional nursing that advances the well-being, academic success and lifelong achievement and health of students.

3. School Nurses Facilitate normal development & positive student response to interventions Promote health & safety, including a healthy environment Intervene with actual & potential health problems

4. Provide case management services Actively collaborate with others to build student & family capacity for adaptation, self-management, self advocacy & learning (NASN 2010)

5. NASN Nurse-to-Student Ratio 1:750 for students in the general population 1:225 in the student populations requiring daily professional school nursing services or interventions 1:125 in student populations with complex health care needs 1:1 may be necessary for individual students who require daily & continuous professional nursing services

6. Kentucky School Nurse Services Provided by: 1. Advance Practice Registered Nurse (APRN) 2. Registered Nurse (RN) 3. Licensed Practical Nurse (LPN) Hold a current Kentucky license from the Kentucky Board of Nursing (KBN) Must know the their individual scope of practice (defined in KRS 314.011)

7. Licensed Practical Nurse LPN is not licensed for independent practice LPN practices under the supervision of a RN, APRN, physician, or dentist Supervision of the LPN does not have to be physically on sight

8. Licensed Practical Nurse KRS 156.502 (2) and 2014 KBN AOS # 15 does not allow the LPN in the school setting to delegate, train or supervise unlicensed school personnel on school health services

9. School Nurses Impact School Achievement/Attendance Improve School Performance/Attendance Serve as the vital link to better care Provide essential services Bridge Education and Health Actively improve the lives of students, families & staff

10. Key School Personnel Education School Nurse Consultant – provides leadership, consultation & technical assistance to local school districts r/t school health services (KRS 156.501) KDPH School Health Nurse Consultant – provides leadership, consultation, & technical assistance to local health departments school nurse programs School Health Coordinator – works with all school personnel, the local BOE, school council, KDE, LHD, Family/Youth Resource Centers (FRYSC), & parents (702 KAR 1:160, Section 5) School Nurses – must have a current KY license Unlicensed school personnel may be delegated to perform school health services when trained according to KRS 156.502 & 702 KAR 1:260, Section 4 (g)

11. Models of Delivery Delivered by local school district employed RN, APRN, LPN, or unlicensed school personnel who have been trained according to KRS 156.502 Local health department personnel contracted by the local school districts Local school district may contract with a hospital or health care provider for a school based center (SBHC)

12. Specialized Services School nurses work to create access to health care for students and families School nurses coordinate & conducts assessment, planning and implementation of individualized health care plans (IHP) School nurses determine if health services can be delegated to Unlicensed Assistive Personnel (UAP) School nurses coordinate evaluation and intervention services School nurses assist students to learn to manage their chronic illness

13. Communicable Disease Control and Prevention Student absences due to infectious diseases cause a loss of millions of school days each year (CDC 2010) School nurse can offer guidance, infection control strategies and disease management techniques Parents role to communicate with schools and local officials r/t possible communicable diseases

14. Communicable Disease Control and Prevention KRS 158.160: Notification to school by parent or guardian of child’s medical condition threatening school safety—Exclusion of child with communicable disease from school—closing of school during epidemic MRSA is not a reportable disease Reportable Disease Form (HSRG: link to DPH form)

15. Communicable Diseases Bloodborne Pathogen Training for School Personnel 1. Required by OSHA 2. Must be reviewed yearly 3. Training must be “interactive – ability to ask questions and receive answers during training session KSBA has OSHA training for school district each year – ask who is responsible for Exposure Control Plan in your district Some school districts have this training online @ KY TRAIN

16. Health Services Medication administration Includes over-the-counter (OTC),daily scheduled, PRN, or emergency (glucagon, diastat, or epinephrine) Insulin administration and carb counting Clinical Procedures Tube feedings and catherizations Trach care and suctioning Ventilators or oxygen therapy

17. Chronic Health Conditions Intervention Overweight/Obesity – one in three children, ages 2 to 19 are overweight Overweight – having excess body weight for a particular height from fat, muscle, bone, water or combination of these Obesity – excess body fat Immediate health effects- Cardiovascular disease (high B/P or cholesterol),pre-diabetes, bone/joint problems

18. Asthma – more than 7 million children have & is one of the biggest contributors to school absences (over 10 million days annually) Schools should 1. Identify & monitor all asthma students 2. Obtain individualized Asthma Action Plans 3. Established standard ER protocols 4. Educate all school personnel 5. Ensure students know policies & procedures for self-carry, administer & quick relief meds

19. Diabetes – Type 1 or 2 is on the rise in children & youth under age 20, 0.26% Care includes monitoring blood glucose several times a day, calculating carbohydrate content of meals, dosing insulin via syringe, pen or pump Each student must have a Diabetes Medical Management Plan (DMMP), Individual Health Plan (IHP), & Emergency Care Plan (ECP)

20. Epilepsy (Seizures) - brain disorder characterized by two or more unprovoked seizures Approximately 70% those diagnosed, the seizures can be controlled with medicine or surgical techniques or devices Can be a life threatening condition May increase the risk of learning, psychosocial & behavioral problems

21. Seizures types include- simple partial, absence, complex partial & generalized tonic-clonic A student should have a seizure action plan for emergency care Plan should include: assess students needs; customize as to treatment, first aid, & accommodations; teach & tailor interventions needed to relevant school personnel & students

22. Allergy and Anaphylaxis Potentially life-threatening allergic reaction that can occur very quickly Causes- allergies to bee stings, insects bites, shellfish, nuts, egg whites, dairy, medications (i.e. antibiotics), mold, latex & other allergens Symptoms will vary, most common- hives, itching flushing, swelling of lips, tongue & roof of mouth Airway often affected, may result in chest & throat tightness, difficulty breathing & swallowing

23. Epinephrine by injection is the prescribed recommended choice of treatment given in the outer thigh Administer at the first signs of anaphylaxis Call EMS for emergency follow-up care Students with known allergies should have an anaphylaxis action plan

24. School Nurse School Year Calendar August 1. Finalize a written school health plan for the year 2. Determine the data need to document for nursing services 3. Prepare health office & supplies 4. Review/update ER care plans & procedures 5. Identify & post list of current personnel trained in CPR & recertification dates

25. School Nurse School Year Calendar August 6. Check records for current Immunizations, physical forms, vision & dental screening forms 7. Plan in-service training with staff – BBP, CPR, Medication Administration, special procedures*(i.e. catherization & tube feeding) * Training only good for current school year (July1-June 30)

26. September Update health records Schedule classroom health presentations Establish a procedure for advance field trip Establish dates for required vision & hearing screening notifications October Complete state immunization report Continue follow-up immunization compliance Review absentee records to identify health problems, requiring nursing intervention Maintain/update IHP and emergency action plans

27. November Continue surveillance of immunization records Review absentee records to identify health problems requiring nursing intervention Conduct classroom presentations on prevention of cold-flu; sore throats; positive health practices Schedule and conduct vision and hearing re-screenings

28. December Review absentee records to identify health problems requiring nursing intervention Continue surveillance of immunization records Review student health records for vision exam and dental screening/exam compliance (must complete before Jan 1) January Review absentee records to identify health problems requiring nursing intervention

29. February-March Review absentee records to identify health problems requiring nursing intervention Complete re-screening for vision and hearing, Review immunization records Review KDE health reports for accuracy

30. April-June Review follow-up referrals on screenings Review care plans & ER actions plans End of the year report due to KDE Submit request to attend a school health related educational program Develop tentative plan for next school year

31. Contact Information Sandi Clark, KDPH School Health Nurse Consultant SandiK.Clark@ky.gov Karen.Erwin, KDE School Nurse Consultant Karen.Erwin@education.ky.gov